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  1. Article ; Online: Organizational Perspectives on Technical Capabilities and Barriers Related to Pediatric Data Sharing and Confidentiality.

    Bedgood, Michael / Kuelbs, Cynthia L / Jones, Veena G / Pageler, Natalie

    JAMA network open

    2022  Volume 5, Issue 7, Page(s) e2219692

    MeSH term(s) Child ; Confidentiality ; Humans ; Information Dissemination ; Organizations
    Language English
    Publishing date 2022-07-01
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.19692
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  2. Article ; Online: Use Characteristics and Triage Acuity of a Digital Symptom Checker in a Large Integrated Health System: Population-Based Descriptive Study.

    Morse, Keith E / Ostberg, Nicolai P / Jones, Veena G / Chan, Albert S

    Journal of medical Internet research

    2020  Volume 22, Issue 11, Page(s) e20549

    Abstract: Background: Pressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a ... ...

    Abstract Background: Pressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a limited supply of highly trained health care professionals, creating a need for scalable technological solutions. Digital symptom checkers are artificial intelligence-supported software tools that use a conversational "chatbot" format to support rapid diagnosis and consistent triage. The COVID-19 pandemic has brought new attention to these tools due to the need to avoid face-to-face contact and preserve urgent care capacity. However, evidence-based deployment of these chatbots requires an understanding of user demographics and associated triage recommendations generated by a large general population.
    Objective: In this study, we evaluate the user demographics and levels of triage acuity provided by a symptom checker chatbot deployed in partnership with a large integrated health system in the United States.
    Methods: This population-based descriptive study included all web-based symptom assessments completed on the website and patient portal of the Sutter Health system (24 hospitals in Northern California) from April 24, 2019, to February 1, 2020. User demographics were compared to relevant US Census population data.
    Results: A total of 26,646 symptom assessments were completed during the study period. Most assessments (17,816/26,646, 66.9%) were completed by female users. The mean user age was 34.3 years (SD 14.4 years), compared to a median age of 37.3 years of the general population. The most common initial symptom was abdominal pain (2060/26,646, 7.7%). A substantial number of assessments (12,357/26,646, 46.4%) were completed outside of typical physician office hours. Most users were advised to seek medical care on the same day (7299/26,646, 27.4%) or within 2-3 days (6301/26,646, 23.6%). Over a quarter of the assessments indicated a high degree of urgency (7723/26,646, 29.0%).
    Conclusions: Users of the symptom checker chatbot were broadly representative of our patient population, although they skewed toward younger and female users. The triage recommendations were comparable to those of nurse-staffed telephone triage lines. Although the emergence of COVID-19 has increased the interest in remote medical assessment tools, it is important to take an evidence-based approach to their deployment.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/diagnosis ; COVID-19/virology ; Child ; Child, Preschool ; Delivery of Health Care, Integrated/methods ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; SARS-CoV-2/isolation & purification ; Symptom Assessment/methods ; Symptom Assessment/standards ; Triage/methods ; Triage/standards ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-11-30
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/20549
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  3. Article ; Online: Effects of Behavioral Economics-Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study.

    Liang, Su-Ying / Stults, Cheryl D / Jones, Veena G / Huang, Qiwen / Sutton, Jeremy / Tennyson, Guy / Chan, Albert S

    JMIR human factors

    2022  Volume 9, Issue 1, Page(s) e34090

    Abstract: Background: Behavioral economics-based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient ... ...

    Abstract Background: Behavioral economics-based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services.
    Objective: We examined the impacts of behavioral economics-based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear.
    Methods: We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics-based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics-based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group). We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear.
    Results: The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits-nudge: 12,537/96,839, 13.0%; control: 2,769/28,530, 9.7%, P<.001; Pap smear-nudge: 8,239/287,149, 2.9%; control: 1,868/120,047, 1.6%; P<.001). Rates of appointment completion were higher for nudge health maintenance reminders for Pap smear (nudge: 67,399/287,149, 23.5% control: 20,393/120,047, 17.0%; P<.001) but were comparable for Medicare wellness visits (nudge: 49,835/96,839, 51.5% control: 14,781/28,530, 51.8%; P=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10).
    Conclusions: Nudges, a behavioral economics-based approach to providing health maintenance reminders, increased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach-framing and modifying language in an electronic message-can have a significant and long-term impact on patient engagement and access to care.
    Language English
    Publishing date 2022-03-30
    Publishing country Canada
    Document type Journal Article
    ISSN 2292-9495
    ISSN (online) 2292-9495
    DOI 10.2196/34090
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  4. Article ; Online: Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria.

    Wang, Marie E / Jones, Veena G / Kane, Miranda / Allan, Jessica M / Maleknia, Lydia / Patel, Ritu / Ip, Wui / Newman, Thomas B / Roberts, Kenneth B / Schroeder, Alan R

    Academic pediatrics

    2023  Volume 24, Issue 1, Page(s) 111–118

    Abstract: Objective: To describe the clinical course of children with positive urine cultures without pyuria who were not given antibiotics initially, identify predictors of subsequent antibiotic treatment, and evaluate the association between subsequent ... ...

    Abstract Objective: To describe the clinical course of children with positive urine cultures without pyuria who were not given antibiotics initially, identify predictors of subsequent antibiotic treatment, and evaluate the association between subsequent treatment and urinary tract infection (UTI) within 30 days.
    Methods: We conducted a multicenter retrospective cohort study of children 1 to 24 months old who had positive urine cultures without pyuria and who were not started on antibiotics upon presentation to 3 health care systems from 2010 to 2021. Outcomes included clinical status at the time urine cultures resulted, escalation of care (emergency department visit or hospitalization) and subsequent antibiotic treatment within 7 days, and subsequent UTI within 30 days of presentation.
    Results: Of 202 included children, 61% were female and median age was 9 months. Of 151 patients with clinical status information when cultures resulted, 107 (70.8%, 95% confidence interval [CI] 62.9-77.9%) were improved. Two of 202 children (1.0%, 95% CI 0.2-4.0%) experienced care escalation. Antibiotics were started in 142 (82.2%) children, and treatment was associated with prior UTI (risk ratio [RR] 1.20, 95% CI 1.15-1.26) and lack of improvement (RR 1.22, 95% CI 1.13-1.33). Subsequent UTI was diagnosed in 2 of 164 (1.2%, 95% CI 0.1-4.3%) treated and 0 of 36 (0%, 95% CI 0-9.7%) untreated children.
    Conclusions: Seventy percent of children with positive urine cultures without pyuria improved before starting antibiotics; however, >80% were ultimately treated. Future research should study the impact of diagnostic stewardship interventions and various urine testing strategies to optimize the management of children evaluated for UTI.retain-->.
    MeSH term(s) Child ; Humans ; Female ; Infant ; Child, Preschool ; Male ; Pyuria/complications ; Pyuria/diagnosis ; Pyuria/drug therapy ; Retrospective Studies ; Urinary Tract Infections/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Disease Progression
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-06-22
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2483385-X
    ISSN 1876-2867 ; 1876-2859
    ISSN (online) 1876-2867
    ISSN 1876-2859
    DOI 10.1016/j.acap.2023.06.023
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    Zs.A 5914: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  5. Article ; Online: Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis.

    Chung, Sukyung / Martinez, Meghan C / Frosch, Dominick L / Jones, Veena G / Chan, Albert S

    Journal of medical Internet research

    2020  Volume 22, Issue 6, Page(s) e16451

    Abstract: Background: Cancellations and rescheduling of doctor's appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take ... ...

    Abstract Background: Cancellations and rescheduling of doctor's appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal.
    Objective: We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates.
    Methods: This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer.
    Results: Of 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 years (versus those aged 65 years or older; all at P<.001). Factors negatively associated with offer acceptance were a higher number of comorbidities (P=.02) and visits scheduled for chronic conditions (versus acute conditions only; P=.002).
    Conclusions: An automated rescheduling system can improve patients' access by reducing wait times for an appointment, with an added benefit of reducing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing the adoption of SMS text messaging offers and targeting older adults or patients with complex conditions, may make the system more patient-centered and help promote wider utilization.
    MeSH term(s) Adolescent ; Adult ; Aged ; Appointments and Schedules ; Case-Control Studies ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Male ; Medical Informatics/methods ; Middle Aged ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2020-06-10
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/16451
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  6. Article ; Online: Use Characteristics and Triage Acuity of a Digital Symptom Checker in a Large Integrated Health System

    Morse, Keith E / Ostberg, Nicolai P / Jones, Veena G / Chan, Albert S

    Journal of Medical Internet Research, Vol 22, Iss 11, p e

    Population-Based Descriptive Study

    2020  Volume 20549

    Abstract: BackgroundPressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a ... ...

    Abstract BackgroundPressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a limited supply of highly trained health care professionals, creating a need for scalable technological solutions. Digital symptom checkers are artificial intelligence–supported software tools that use a conversational “chatbot” format to support rapid diagnosis and consistent triage. The COVID-19 pandemic has brought new attention to these tools due to the need to avoid face-to-face contact and preserve urgent care capacity. However, evidence-based deployment of these chatbots requires an understanding of user demographics and associated triage recommendations generated by a large general population. ObjectiveIn this study, we evaluate the user demographics and levels of triage acuity provided by a symptom checker chatbot deployed in partnership with a large integrated health system in the United States. MethodsThis population-based descriptive study included all web-based symptom assessments completed on the website and patient portal of the Sutter Health system (24 hospitals in Northern California) from April 24, 2019, to February 1, 2020. User demographics were compared to relevant US Census population data. ResultsA total of 26,646 symptom assessments were completed during the study period. Most assessments (17,816/26,646, 66.9%) were completed by female users. The mean user age was 34.3 years (SD 14.4 years), compared to a median age of 37.3 years of the general population. The most common initial symptom was abdominal pain (2060/26,646, 7.7%). A substantial number of assessments (12,357/26,646, 46.4%) were completed outside of typical physician office hours. Most users were advised to seek medical care on the same day (7299/26,646, 27.4%) or within 2-3 days (6301/26,646, 23.6%). Over a quarter of the assessments indicated a high degree of urgency (7723/26,646, ...
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
    Subject code 302
    Language English
    Publishing date 2020-11-01T00:00:00Z
    Publisher JMIR Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Digital Symptom Checker Usage and Triage: Population-Based Descriptive Study in a Large North American Integrated Health System

    Morse, Keith E / Ostberg, Nicolai P / Jones, Veena G / Chan, Albert S

    J. med. internet res

    Abstract: BACKGROUND: Pressure on the United States (US) healthcare system has been increasing due to a combination of aging populations, rising healthcare expenditures and, most recently, the COVID-19 pandemic. Responses are hindered in part by a reliance on a ... ...

    Abstract BACKGROUND: Pressure on the United States (US) healthcare system has been increasing due to a combination of aging populations, rising healthcare expenditures and, most recently, the COVID-19 pandemic. Responses are hindered in part by a reliance on a limited supply of highly trained healthcare professionals, creating a need for scalable technological solutions. Digital symptom checkers are artificial intelligence (AI)-supported software tools that use a conversational "chatbot" format to support rapid diagnosis and consistent triage. The COVID-19 pandemic has brought new attention to these tools, with the need to avoid face-to-face contact and preserve urgent care capacity. However, evidence-based deployment of these chatbots requires an understanding of user demographics and associated triage recommendations generated by a large, general population. OBJECTIVE: In this study we evaluate the user demographics and levels of triage acuity provided by one symptom checker chatbot deployed in partnership with a large integrated health system in the US. METHODS: Population-based descriptive study including all online symptom assessments completed on the website and patient portal of the Sutter Health system (24 hospitals in Northern California) from April 24th, 2019 to February 1st, 2020. User demographics were compared to relevant US Census population data. RESULTS: A total of 26,646 symptom assessments were completed during the study period. Most assessments (17,816/26,646, 66.9%) were completed by female users. Mean user age was 34.3 years (SD: 14.4 years), compared to a median age of 37.3 years of the general population. The most common initial symptom was 'abdominal pain' (2,060/26,646, 7.7%). A substantial portion (12,357/26,646, 46.4%) was completed outside of typical physician office hours. Most users were advised to seek medical care the same day (7,299/26,646, 27.4%) or within 2-3 days (6,301/26,646, 23.6%). Over one quarter of assessments required a high degree of urgency (7,723/26,646, 29.0%). CONCLUSIONS: Users of the symptom checker chatbot were broadly representative of our patient population, though skewed towards younger and female users. Triage recommendations are comparable to those of nurse-staffed phone triage lines. While the emergence of COVID-19 increases the enthusiasm for remote medical assessment tools, it is important to take an evidence-based approach to their deployment.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #918048
    Database COVID19

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  8. Article ; Online: Adiposity and Cortisol Response to Stress in Indian Adolescents.

    Krishnaveni, G V / Jones, A / Veena, S R / Somashekara, R / Karat, S C / D Fall, C H

    Indian pediatrics

    2017  Volume 55, Issue 2, Page(s) 125–130

    Abstract: Objective: We examined associations of different adiposity measures with cortisol responses during the Trier Social Stress Test for children (TSST-C).: Design: Descriptive study.: Setting: Holdsworth Memorial Hospital, Mysore, India.: ... ...

    Abstract Objective: We examined associations of different adiposity measures with cortisol responses during the Trier Social Stress Test for children (TSST-C).
    Design: Descriptive study.
    Setting: Holdsworth Memorial Hospital, Mysore, India.
    Participants: Adolescents aged 13.5y from a birth cohort were recruited (N=269, 133 boys).
    Methods: The stressor (TSST-C) was 5-minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar 'judges'. Salivary cortisol concentrations were measured at baseline and at regular intervals after TSST-C. Weight, height, sub scapular and triceps skinfold thickness, and waist and hip circumference were measured, and percentage body fat was estimated (fat%; bioimpedance). Body mass index (BMI) and Waist-to-hip ratio (WHR) were calculated. All variables were converted into within-cohort SD scores before analysis. Stress-induced change in cortisol concentrations from baseline (cortisol response) was examined in relation to adiposity.
    Results: Stress increased cortisol concentrations significantly from baseline (mean (SD): 5.5 (6.4) ng/mL; P<0.001). Higher WHR was associated with lower cortisol response at 20 and 30-minutes after stress (~0.13 SD decrease in cortisol response per SD higher WHR, P<0.05). Higher fat% was also associated with lower cortisol response only in girls 20-minutes post-stress (0.23 SD lower response per SD higher fat%, P=0.004). Sum of skinfold thickness and BMI were not associated with cortisol responses.
    Conclusion: Abdominal adiposity is associated with reduced hypothalamic-pituitary-adrenal axis reactivity to stress in this adolescent population.
    MeSH term(s) Adiposity/physiology ; Adolescent ; Body Mass Index ; Female ; Humans ; Hydrocortisone/analysis ; Hypothalamo-Hypophyseal System ; India/epidemiology ; Male ; Pituitary-Adrenal System ; Psychological Tests ; Saliva/chemistry ; Stress, Psychological/epidemiology ; Stress, Psychological/physiopathology
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2017-12-14
    Publishing country India
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 402594-5
    ISSN 0974-7559 ; 0019-6061
    ISSN (online) 0974-7559
    ISSN 0019-6061
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 859: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  9. Article ; Online: Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care

    Chung, Sukyung / Martinez, Meghan C / Frosch, Dominick L / Jones, Veena G / Chan, Albert S

    Journal of Medical Internet Research, Vol 22, Iss 6, p e

    Retrospective Case-Control Analysis

    2020  Volume 16451

    Abstract: BackgroundCancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the ... ...

    Abstract BackgroundCancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal. ObjectiveWe examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates. MethodsThis study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer. ResultsOf 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 ...
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
    Subject code 070
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher JMIR Publications
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

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  10. Article ; Online: Assessment of Accuracy and Usability of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network.

    Stults, Cheryl D / Li, Jiang / Frosch, Dominick L / Krishnan, Hari / Smith-McCurdy, Gregg / Jones, Veena G / Chan, Albert S

    JAMA network open

    2019  Volume 2, Issue 12, Page(s) e1917445

    Abstract: Importance: Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed.: Objective: To assess accuracy and initial user ... ...

    Abstract Importance: Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed.
    Objective: To assess accuracy and initial user experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third-party payers.
    Design, setting, and participants: This quality improvement study included patients aged 18 years and older at an integrated health care system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019.
    Main outcomes and measures: Tool accuracy and user experience and satisfaction.
    Results: As of April 30, 2019, 4610 estimates (3569 [77.4%] via internet; 1041 [22.6%] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287 estimates (83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (44.0%) with an income of $100 000 per year or higher. Mean (SD) age was 46.8 (13.1) years. Ninety-nine participants (79.2%) found the tool easy to use, 109 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate.
    Conclusions and relevance: This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the next steps for the tool.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Care/economics ; Ambulatory Care/standards ; California ; Data Accuracy ; Delivery of Health Care, Integrated/economics ; Delivery of Health Care, Integrated/standards ; Female ; Health Care Costs ; Humans ; Insurance, Health, Reimbursement ; Internet ; Male ; Middle Aged ; Patient Portals ; Patient Satisfaction/statistics & numerical data ; Qualitative Research ; Quality Assurance, Health Care ; Quality Improvement ; Young Adult
    Language English
    Publishing date 2019-12-02
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2019.17445
    Database MEDical Literature Analysis and Retrieval System OnLINE

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