<p> The implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 prompted the integration of electronic medical records into clinical operations. The HITECH Act contained requirements under the meaningful use program to offer tethered patient portal systems allowing patients to view health care information online. Utilization of these portals, however, has been low among the general population and its adoption among minority and non-English-speaking patients even lower. The purpose of this study was to investigate how Hispanics living in Texas, who often prefer Spanish as the primary language, access personal health care information online through the use of a patient portal. The study examined if the number of times a patient accessed the patient portal varied by demographic measures (gender, age, ethnicity, and insurance status), as well as average neighborhood income and language preference. The study also investigated differences in demographics and language preference between registered and non-registered patients. This quantitative, correlational study used archival data to analyze 500 randomly selected medical records at a medical clinic an academic medical center in Texas seen between January 2015 and June 2016. The dataset contained an equal pairing of registered (<i>n</i> = 250) and non-registered (<i> n</i> = 250) patient portal users drawn from the electronic medical record and the patient portal system. Data analyses included Pearson&rsquo;s r correlations, independent t-tests, multiple regression models, one-way ANOVA, and chi-square analyses. Results demonstrate significant differences between age and patient portal use with older patients accessing the patient portal more frequently than younger patients. Hispanics and non-English-speaking patients are less likely to register or utilize the patient portal. Future research should investigate solutions to overcoming access and language barriers in this population. Given that patient portal access is one measure of patient engagement, elucidating how to further involve non-English-speaking Hispanics in health care has the potential to improve individual health outcomes.</p><p>

<p> Japanese Americans comprise approximately 20% of the State of Hawaii&rsquo;s population and Japanese is the most common language used by first-generation Japanese Americans. As a result, delivering effective care to Hawaiian residents means that providers must deliver services in a culturally sensitive manner. Accomplishing this aim becomes increasingly difficult within elderly populations, when patients are dealing with physical and cognitive limitations as well as cultural and language barriers. This study examined the question: How can Hawaii eldercare professionals improve patient eldercare services to Japanese immigrants, taking into consideration Japanese language and cultural norms? </p><p> This study utilized a qualitative grounded theory design. One elder daycare facility and one hospice were selected as the setting for the study. From these settings, four participants were recruited from the hospice and three were recruited from the daycare. Participants&rsquo; job titles included nurse, massage therapist, grief counselor, daycare director, and activity aide. Participants were asked to provide their demographic information, report on the services they deliver and patient communication practices they utilize, and share their views about quality of care and desired patient outcomes. The interview data were analyzed using open coding and axial coding, culminating in the creation of an integrated theory. </p><p> Examination of the study data indicated that delivering culturally sensitive eldercare requires efforts to (a) understand patients&rsquo; history, beliefs, worries, goals, and diagnosis; (b) educate patients to ease concerns and elicit self-supportive behaviors; and (c) respect and adapt to patients&rsquo; characteristics and needs. Recommendations for eldercare professionals are to improve education and training of all eldercare staff, promote Japanese facilities and Japanese eldercare programming, and expand caregiver roles. Additionally, more research is needed to confirm and extend the present study&rsquo;s findings&mdash;specifically using a much larger sample size, including patient and family perspectives, and examining differences among Japanese immigrant subgroups.</p><p>

<p> <b>Background:</b> Hypertension (HTN), also referred to as a silent killer, has been the leading cause of mortality in the world for more than 10 years. Uncontrolled HTN is associated with cardiovascular complications like stroke, heart failure and chronic kidney disease. Disparity is noted in hypertension prevalence, blood pressure control, cardiovascular burden and adherence to hypertension treatment regimens, with worse consequences for Blacks/African Americans compared to their racial counterparts. Multiple factors account for these differences and include biological, psychological and socio-cultural issues. Despite the many salient factors identified to be associated with adherence to hypertensive treatment regimens, as well as current strategies in place, high cardiovascular burden from uncontrolled HTN persist in Black communities.</p><p> <b>Purpose:</b> To determine the strongest factors associated with adherence to hypertension treatment regimens among all of the most salient factors identified by prior research, within the context of a community sample of Black/African Americans residing in an urban setting.</p><p> <b>Design:</b> Cross-sectional, correlation design.</p><p> <b>Theoretical Framework:</b> The Biopsychosocial model framework. Data Analysis: Data analysis consisted of descriptive and bivariate analysis of the predictor variables. Significant variables was analyzed using multiple linear regression model to identify the strongest variables predicting adherence. </p><p> <b>Result:</b> Four factors remained significant predictors to adherence in the final regression model: Annual income [$10,000-$20,000 (&beta;= .21, p = .04); annual income $40,001-$80,000 (&beta; = .25, p = .03), Full-time work status (&beta;= -.23 p = .04), Last blood pressure within normal range (&beta;= .19, p = .02) and Depressive symptoms (&beta; = -.20, p = .02).</p><p> <b>Implications:</b> The identification of mainly inter-related psychosocial factors (depressive symptoms, income and employment status) as significant predictors of adherence in this sample has implications for priority psychosocial assessment (depression screening in particular), when rendering care to hypertensive Black/African American patients.</p><p> <i>Keywords:</i> hypertension, hypertension control disparity, Blacks or African Americans, antihypertensive treatment regimens, adherence </p><p>

abstract: As technology has advanced in recent years, tablet devices have started to make their way into all walks of life. Yet, many medical documentation processes still see the use of paper. Though the paper based documentation method has been shown to be effective for some purposes, the introduction of tablet devices has the potential to make the documentation processes a lot smoother. In this thesis, tablet based documentation systems are reviewed, and based on this, a new custom application is developed that medical staff can use with ease. This new application, developed for an iPad is one where users can fully customize their own forms for different uses in the intensive care unit for resuscitation scenarios. The thesis discusses the architecture behind this application along with designing different elements of the system. Through this thesis project, the application was evaluated to see if such a complex documentation process can be easily used and created on a tablet device. The medical staff surveyed, responded positively to the use of the application and agreed that the electronic documentation usage and creation is a powerful tool that could help improve resuscitation practice by making it more efficient. / Dissertation/Thesis / Survey Responses / Masters Thesis Engineering 2016

abstract: For the past decade, mobile health applications are seeing greater acceptance due to their potential to remotely monitor and increase patient engagement, particularly for chronic disease. Sickle Cell Disease is an inherited chronic disorder of red blood cells requiring careful pain management. A significant number of mHealth applications have been developed in the market to help clinicians collect and monitor information of SCD patients. Surveys are the most common way to self-report patient conditions. These are non-engaging and suffer from poor compliance. The quality of data gathered from survey instruments while using technology can be questioned as patients may be motivated to complete a task but not motivated to do it well. A compromise in quality and quantity of the collected patient data hinders the clinicians' effort to be able to monitor patient's health on a regular basis and derive effective treatment measures. This research study has two goals. The first is to monitor user compliance and data quality in mHealth apps with long and repetitive surveys delivered. The second is to identify possible motivational interventions to help improve compliance and data quality. As a form of intervention, will introduce intrinsic and extrinsic motivational factors within the application and test it on a small target population. I will validate the impact of these motivational factors by performing a comparative analysis on the test results to determine improvements in user performance. This study is relevant, as it will help analyze user behavior in long and repetitive self-reporting tasks and derive measures to improve user performance. The results will assist software engineers working with doctors in designing and developing improved self-reporting mHealth applications for collecting better quality data and enhance user compliance. / Dissertation/Thesis / Masters Thesis Computer Science 2017

abstract: The technological revolution has caused the entire world to migrate to a digital environment and health care is no exception to this. Electronic Health Records (EHR) or Electronic Medical Records (EMR) are the digital repository for health data of patients. Nation wide efforts have been made by the federal government to promote the usage of EHRs as they have been found to improve quality of health service. Although EHR systems have been implemented almost everywhere, active use of EHR applications have not replaced paper documentation. Rather, they are often used to store transcribed data from paper documentation after each clinical procedure. This process is found to be prone to errors such as data omission, incomplete data documentation and is also time consuming. This research aims to help improve adoption of real-time EHRs usage while documenting data by improving the usability of an iPad based EHR application that is used during resuscitation process in the intensive care unit. Using Cognitive theories and HCI frameworks, this research identified areas of improvement and customizations in the application that were required to exclusively match the work flow of the resuscitation team at the Mayo Clinic. In addition to this, a Handwriting Recognition Engine (HRE) was integrated into the application to support a stylus based information input into EHR, which resembles our target users’ traditional pen and paper based documentation process. The EHR application was updated and then evaluated with end users at the Mayo clinic. The users found the application to be efficient, usable and they showed preference in using this application over the paper-based documentation. / Dissertation/Thesis / Masters Thesis Computer Science 2018

Clinical decisions should take into account the clinical risk and benefit of a new intervention compared to the reference treatment. A method was developed to compare multiple competing interventions using a clinical cost-effectiveness approach. A meta-analysis was conducted to estimate the clinical cost (major bleeding) and benefit (averted venous thromboembolism) of thromboprophylaxis with different anticoagulants in orthopedic surgery. The increment in cost and benefit of anticoagulants compared to placebo were calculated using replications of the values obtained through Monte Carlo simulations. Net clinical benefit was calculated for each replication across a range of risk acceptance values (risk-benefit acceptability threshold). Multiple anticoagulants were compared by calculating the probability that each agent had of achieving the highest net clinical benefit. The preferred anticoagulants varied depending on risk acceptance, type of surgery, bleeding and thrombosis definitions, and timing of anticoagulant initiation. This method allowed comparing multiple interventions in the absence of randomized trials.

The World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) was developed for chemical rather than biological products. The ability of the PIDM to meet the needs of vaccine safety is of international public health importance. Three studies were conducted: (1) a survey of authorities responsible for reporting adverse events following immunizations (AEFIs); (2) an analysis of the WHO Adverse Reactions Database; and (3) a systematic review to identify and compare Bayesian methods used in drug and vaccine signaling. Communication between national surveillance authorities and lack of vaccine-specific terminologies are issues of concern. Many AEFI reports are not forwarded to the PIDM, and reporting timeliness and regularity should be improved. Few studies have examined the use of Bayesian methods in vaccine signaling. Vaccines should be recognized as a distinct group of drugs. Additional staff dedicated to AEFI reporting and vaccine signaling would be a valuable asset to the PIDM.

In 2001, the Ontario provincial government passed an act to minimize the use of physical and chemical restraints in hospitals. This study utilized data from the Ontario Chronic Care Patient System (OCCPS) from April 1998 to March 2004. Data were analyzed using a simple interrupted time series design with visual and ITSACORR analysis to evaluate whether the act has resulted in a change in prevalence rates of physical restraints among elderly patients in Ontario's complex continuing care beds, both province wide and by facility type (i.e., rural, urban, small, large, private or public). Provincial legislation to minimize the use of physical restraints was not effective. ITSACORR analysis coupled with visual analysis can be a useful combination of instruments to assess brief interrupted time series although neither method alone is without limitations.

This work presents doctors with a model of the estimated degree of risk of rare and important neonatal outcomes to aid in better decisions and improved allocation of equipment and resources. An extensive list of admission day parameters is reduced to minimum variable sets to create models for outcomes that are relevant to decision-making in the neonatal intensive care unit. Models are applied to a special collection of cases and compared to neonatologists' risk estimates. A comparative analysis of physician's predictions and the models' discrimination abilities highlights areas of success and areas that can be improved for future trials. Doctors responded positively to the prediction interface concept and to the estimated risk stratification models. Physicians' strengths identified outcomes that could benefit from increased sensitivity. A substantial effort was made to conduct the usability and performance evaluations within the ethical standards that are especially important for engineering healthcare management applications.