The health care profit pool: who stands to gain and lose in the digital economy?
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Consumer Behavior↗
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Stage of regular exercise and health-related quality of life.
BACKGROUND: Research on cognitive factors and motivational readiness for exercise is important for increasing our understanding of behavior change among those with sedentary lifestyles. This study examines stage of change for regular exercise and self-perceived quality of life. METHODS: Data are from 1,387 respondents to a random digit dial survey of health behaviors. Stage of change is assessed with a single item, and individuals are classified with respect to intention and exercise behavior. Quality of life is assessed with the SF-36, a multidimensional measure of health-related quality of life. RESULTS: Exercise stage is associated with self-perceived quality of life. The three areas most strongly related were physical functioning, general health perceptions, and vitality. Physical functioning scores were lowest in precontemplation and highest in maintenance. Vitality and mental health scales were related to exercise behavior, but not to intention. CONCLUSIONS: Cognitions about self-perceived quality of life vary across the stages of change, with those who are least prepared to adopt regular exercise reporting the lowest levels of quality of life. These findings suggest that cognitive-motivational messages designed to emphasize quality of life benefits associated with exercise may be useful intervention strategies for people who are less motivationally ready to change.
Adult↗
Saving time, improving satisfaction: the impact of a digital radiology system on physician workflow and system efficiency.
The objective of the study was to assess UC Davis Health System's transition to digital radiology. The study involved pre- and post-PACS analyses of workflow and costs, physician satisfaction surveys, and self-recorded radiology interactions by on-call residents. The study revealed significant results. Before the PACS implementation, physicians spent one to three hours searching for films daily and were dissatisfied with radiology services. After implementation, images were readily available, physicians were more likely to view and interpret images themselves, and they reported increased satisfaction. From real-time reporting, residents viewed studies with radiologists 90.2 percent less often. Average image search time decreased, from 16 to 2 minutes, saving 21.5 physician years, worth dollar 1,034,150 annually. Reductions in film printing (73.4 percent) and file clerk full-time equivalents (50.3 percent) saved dollar 1,001,452 annually, and freed up 1,218 hospital and 8,108 warehouse square feet, worth dollar 2,018,320. As a result, UCDHS's digital radiology system improved clinician satisfaction and workflow, increased clinician image viewing, and decreased clinician engagement with radiologists. System implementation saved 21 physician years and dollar 2 million annually.
California↗
Establishing the level of digitization for wrist and hand radiographs for the third National Health and Nutrition Examination Survey.
In the third National Health and Nutrition Examination Survey (NHANES III) conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, radiographs of the hands and knees were taken of participants 60 years and older as part of the study of arthritis and musculoskeletal conditions. The purpose of the study was to decide the digitizing resolution to be used for these radiographs. A set of wrist and hand radiographs (N = 49) was graded by two radiologists for degree of bone erosions and served as a "gold standard." The radiographs were then digitized at three resolution levels; low-resolution 150 microns (2001 x 1634 x 12 bit matrix); intermediate-resolution 100 microns (3000 x 2400 x 12 bit matrix); and high-resolution 50 microns (4900 x 3000 x 12 bit matrix). A comparison of the digital images versus the gold standard reading was made at the three resolutions by two radiologists. Kappa statistics suggested fair (K > .4) to excellent (K > .75) agreement between the gold standard and the images at all levels. Intraclass correlation coefficient suggested high agreement between readers (ICC > .5), with minimal individual reader effect. Variance component estimates showed that the major contribution (78-83%) to scoring came from variability in the images themselves, not from the readers. The 100 microns resolution was selected over the 150 and 50 microns on the basis of practical considerations such as storage requirements, display time, and easier manipulation of the digital images by the readers.
Arizona↗
A theory for classification of health care organizations in the new economy.
Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.
Decision Making, Computer-Assisted↗
Mobile computing in a New Zealand Bachelor of Nursing Programme.
Mobile computing is rapidly becoming a reality in New Zealand health care settings. Personal Digital Assistants (PDAs) are the most frequently used of these mobile technologies, giving nurses access to clinical learning resources, including drug references, medical encyclopaedias and diagnostic information. The implementation of mobile computing at Waikato Institute of Technology (Wintec) will ensure graduates of our Bachelor of Nursing Programme are able to meet health care service demands for knowledge in contemporary information technologies as well as the information technology requirements defined by the Nursing Council of New Zealand and the Health Practitioners Competency Assurance Act 2003 for registration as a nurse in New Zealand. This opinion paper presents strategies for the implementation of mobile computing as a core element of the curriculum for the Bachelor of Nursing Programme at Wintec in Hamilton, New Zealand.
Computers, Handheld↗
User Engagement and Feature Preferences in an AI-Powered mHealth Intervention for Diabetes Prevention: Secondary Analysis of a Randomized Controlled Trial.
BACKGROUND: Prediabetes is highly prevalent and increasing globally, yet lifestyle interventions remain underused. AI-driven mobile health (mHealth) tools can help scale diabetes prevention efforts, but the key factors driving their success are not well understood. OBJECTIVE: This post hoc secondary analysis of a randomized controlled trial (RCT) aimed to characterize the most valued features and the role of user engagement in outcomes of a fully automated mHealth intervention for diabetes prevention. METHODS: Data from 151 participants with prediabetes and overweight or obesity who were assigned to an AI-based diabetes prevention program (Sweetch) in a parent RCT (NCT05056376) were analyzed. Engagement (defined as the total number of days the app was used) was categorized into tertiles (low, medium, and high). Baseline characteristics were compared across engagement groups using ANOVA, Kruskal-Wallis, and chi-square tests, and regression models assessed the association between engagement and achievement of diabetes risk reduction outcomes (≥5% weight loss, ≥4% weight loss with ≥150 min/week of physical activity, or ≥0.2 percentage point reduction in hemoglobin A1c [HbA1c] at 12 months). Perceived usefulness of intervention features was surveyed at 12 months. RESULTS: Median engagement was 98 (IQR 34-232) days. Older age (P<.001) and lower baseline BMI (P=.04) were significantly associated with higher engagement. Compared with low engagement, high engagement was associated with greater odds of achieving the composite diabetes risk reduction outcome (odds ratio [OR] 2.59, 95% CI 1.11-6.01; P=.03), ≥5% weight loss (OR 3.31, 95% CI 1.16-9.42; P=.03), and ≥0.2 percentage point reduction in HbA1c (OR 3.57, 95% CI 1.19-10.75; P=.02). Participants most frequently rated weight tracking, physical activity tracking, and the digital body weight scale as the features that were most helpful for achieving their health goals. CONCLUSIONS: Higher engagement with an AI-driven intervention requiring no human intervention was associated with improved diabetes risk reduction. Contrary to concerns about lower digital literacy, older adults engaged with the intervention more than younger adults. Features related to weight and physical activity tracking were most valued by patients in the program. TRIAL REGISTRATION: ClinicalTrials.gov NCT05056376; https://clinicaltrials.gov/study/NCT05056376.
Humans↗
[A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation].
The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.
Female↗
Prostate cancer screening attitudes and continuing education needs of primary care physicians.
BACKGROUND: In May 2003, a survey questionnaire was distributed to all licensed primary care physicians in Newfoundland and Labrador. The objective was to examine the attitudes, self-reported practices, and continuing medical education (CME) preferences of primary care physicians as they pertain to prostate cancer screening. METHODS: Data was obtained from 485 primary care physicians using self-reports of prostate cancer screening practices, attitudes towards prostate cancer screening, and CME preferences. Respondents' characteristics were also collected (eg, gender, years of experience). RESULTS: A majority of respondents screen asymptomatic male patients for prostate cancer. Screening behaviour was related to high volume practice settings, fee-for-service and increased with patient age. Most common reasons for screening were family history, age of patient, and patient request. Majority of physicians agreed that prostate screening should be routinely performed on all men beginning at age 50, however half of physicians believe there is lack of evidence to support digital rectal examination (DRE) and one-third of physicians do not believe the prostate-specific antigen (PSA) nor DRE are accurate screening tests. Areas of greatest interest for CME included topics related to prostate cancer screening effectiveness, strategies for prevention, sexual dysfunction, available treatments and their side effects, and management options. CONCLUSION: Physicians are supportive of the value of screening, however the reliability of and evidence to support DRE and PSA as prostate cancer screening tests are in question. CME which addresses issues surrounding prostate screening and areas related to patient education and counselling are of greatest need.
Attitude of Health Personnel↗
[National public health information system].
Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies.
Croatia↗
Vertebral morphometry derived from digital images.
OBJECTIVE: We describe a method for capturing measurement data directly from digitized images using specialized software and high-resolution workstations. We have evaluated the reliability, accuracy, and reproducibility of this method in an international clinical trial involving vertebral morphometry. MATERIALS AND METHODS: Accuracy was determined using clinical radiographs measured with vernier calipers and a film phantom. Intra- and interobserver variabilities were assessed, and longitudinal reproducibility was evaluated. As part of the trial, spinal radiographs were collected from more than 200 international health care facilities and digitized at four screening centers. Digitized images were stored and sent to our central facility for morphometry and archiving. Timeliness and variability of the process were tracked. RESULTS: Relative accuracy was nearly 100%. Correlation with clinical measurements was high (r = .96; p < .05). The mean coefficient of variation for interobserver variability was 2%. Intraobserver variation was 3-5%. The coefficient of variation for longitudinal reproducibility ranged from 4% to 6%. After 9 months of operation, our trial included 9494 patients. Of approximately 36,000 radiographs, 98% passed quality review. Only 1% of vertebral levels were not measurable. Hardware and software problems were minimal. CONCLUSION: The use of digitized images for morphometry is accurate, reproducible, and convenient. When applied to a large-scale clinical trial, it offers unique advantages that may justify the cost and complexity that exceed those of conventional radiographs.
Female↗
Random digit dialling and Electronic White Pages samples compared: demographic profiles and health estimates.
OBJECTIVE: To compare the methodologies of and health estimates derived from two telephone household survey methods. In particular, to establish if White Pages telephone listings provide a relatively unbiased sampling frame for population health surveys. METHOD: In South Australia in 1998, a health survey questionnaire was administered by telephone to two randomly selected population samples. The first method used EWP (Electronic White Pages, n = 6,012), which contains all listed residential telephone numbers as the sampling frame. The results were compared to a RDD (random digit dialling, n = 3,080) sample where all listed and unlisted telephone numbers were included in the sampling frame. Demographic variables and health estimates were compared between the surveys, and then compared to a 'gold standard' door-to-door household survey conducted concurrently. RESULTS: The response rate for EWP (83.8%) exceeded that of RDD (65.4%). More than four times as many calls were required per completed interview in RDD. Demographic profiles and health estimates were substantially similar. CONCLUSIONS: EWP requires fewer telephone calls and enables approach letters establishing the bona fides of the survey to be sent to each selected address before calling, increasing the response rate. RDD is a more inclusive sampling frame but also includes non-connected and business numbers, and offers no significant advantages in providing health estimates. IMPLICATIONS: There are substantial methodological and cost advantages in using EWP over RDD as the sampling, frame for population health surveys, without introducing significant bias into health estimates.
Adolescent↗
DICOM versus HL7 for modality interfacing.
Digital modalities such as CT, MRI, Ultrasound and Computerized Radiography systems, generating softcopy images to be used by a Picture Archiving and Communication System (PACS), need to identify the images properly in order to retrieve and manage them. In many cases, a technologist re-enters patient demographic and study related information at the modality, even although it is usually already present somewhere in the hospital information system (IS). In order to achieve a higher level of efficiency and uniquely identify the created image objects, it is obvious that an interface between the IS and modality to exchange this information is highly desired. There are two options for a modality vendor to implement an IS interface, either using the Health Level (HL7) or Digital Imaging Communication in Medicine (DICOM) communication standard. This paper will explain characteristics of both protocols, and demonstrate that it is preferred to use DICOM versus HL7. In addition, it will show that DICOM is supported by most modality vendors, based on the result of a poll of their Modality Worklist versus HL7 support.
Diagnostic Imaging↗
[Past, present and future of digital pathology].
The four main aspects of applied medical information technology, which change the traditional systems of the entire health service are signal and data processing, digital modelling and interface optimisation. The information technology serving individual clinical specialties including clinical histopathology is changing at each of the four levels resulting in transformation of the communication paradigms. The object of investigation in histopathology is the digital slide, which is accessible throughout the world with no time or geographical limits. It permits the digital modelling of routine histological and/or cytological slide and it also allows measurements by using image analysis or stereology software packages. The electronic slide can be viewed, examined and diagnosed on a computer connected to a microscope, a new interface in diagnostic histopathology. This study describes the main theoretical and practical aspects, including challenges, of digital pathology and it also discusses the conditions required for successful information management. It reviews the experiences of the last one and half decades gained in the field of pathological information technology in Hungary including its main episodes and milestones of development. Introducing its present state, this paper describes the concept and the mode of investigation of the digital slide. It shows the development and use of a virtual microscope in Hungary. Based on know-how including the British experience this review describes the possible uses of digital slides, which by improving communication could have a positive effect on the entire health care system. It summarises the possible and necessary components of a digital pathology laboratory, which may include the new Slide Archive and Communication System (SACS). Using experimental data it mentions the possibility of generating primary digital pathological sample and producing the so called optical biopsy with no need for removing tissue from the patient.
Analog-Digital Conversion↗
A paid radio advertising campaign to promote parent-child communication about alcohol.
This study assessed the impact of a paid radio commercial designed to promote parent-child communication about alcohol use and sponsored by the Bureau of Substance Abuse Services, Massachusetts Department of Public Health. A random-digit-dial telephone survey of parents or guardians of children ages 10-17 years was conducted after a four-week advertising flight. Respondents with unassisted recall of the commercial more often disagreed that parent-child discussion is useful only if children have begun to experiment with alcohol, and more often reported having three or more parent-child discussions about alcohol compared to those who did not recall the commercial. Findings suggest the potential benefit of paid media campaigns to encourage parents to talk with their children about alcohol.
Adolescent↗
Influenza and tetanus immunization. Are adults up-to-date in rural Alberta?
PURPOSE: To discover what proportion of adults residing within the boundaries of a rural health district were up-to-date with influenza and tetanus vaccinations. METHODS: A directory-seeded, random digit dial telephone survey of health knowledge, attitudes, and practices was conducted in summer 1993. Eligible subjects were aged 16 or older, lived within health district boundaries, and spoke English. RESULTS: Just over half (57.5%) of people aged 65 and older had received influenza vaccine in the previous 12 months, and 55.4% of people 16 years and older had received tetanus vaccine in the last 10 years (93% of people aged 16 to 24 were covered, but only 20.5% of people aged 65 or older). Most (89.8%) of those 65 and older knew that influenza vaccine was recommended for people their age. Only 59% of respondents knew that influenza vaccine was recommended for people with chronic health conditions, regardless of age. CONCLUSION: Among adults, coverage with influenza and tetanus vaccines varies with age, but is generally unsatisfactory. Rates in this rural area of Alberta were similar to Canadian rates for tetanus vaccine coverage but higher for influenza vaccine coverage.
Adolescent↗
Silicosis surveillance in New Jersey: targeting workplaces using occupational disease and exposure surveillance data.
To identify workplaces in New Jersey with potential for silica exposure, the New Jersey Department of Health compared four-digit Standard Industrial Classifications (SICs) identified by three different data sources: the National Occupational Exposure Survey (NOES), a new Jersey silicosis case registry, and regulatory agency compliance inspections in New Jersey. In total, the three data sources identified 204 SICs in New Jersey with potential for silica exposure. Forty-five percent of these SICs were identified by NOES only, 16% by registry cases only, 6% by compliance inspections only, and 33% by two or more sources. Since different surveillance sources implicate different SICs, this type of analysis is a useful first step in planning programs for prevention of silicosis.
Humans↗
Reliability and accuracy of dermatologists' clinic-based and digital image consultations.
BACKGROUND: Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations. OBJECTIVE: Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations. METHODS: One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared. RESULTS: Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy. CONCLUSION: Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.
Adult↗