Public preferences about secondary uses of electronic health information.

Importance: As health information technology grows, secondary uses of personal health information offer promise in advancing research, public health, and health care. Public perceptions about sharing personal health data are important for establishing and evaluating ethical and regulatory structures to oversee the use of these data.

Objective: To measure patient preferences about sharing their electronic health information for secondary purposes (other than their own health care).

Crowdsourcing--harnessing the masses to advance health and medicine, a systematic review.

Objective: Crowdsourcing research allows investigators to engage thousands of people to provide either data or data analysis. However, prior work has not documented the use of crowdsourcing in health and medical research. We sought to systematically review the literature to describe the scope of crowdsourcing in health research and to create a taxonomy to characterize past uses of this methodology for health and medical research.

Behavioral economics holds potential to deliver better results for patients, insurers, and employers.

Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health.

Provider dismissal policies and clustering of vaccine-hesitant families: an agent-based modeling approach.

Many pediatric practices have adopted vaccine policies that require parents who refuse to vaccinate according to the ACIP schedule to find another health care provider. Such policies may inadvertently cluster unvaccinated patients into practices that tolerate non vaccination or alternative schedules, turning them into risky pockets of low herd immunity. The objective of this study was to assess the effect of provider zero-tolerance vaccination policies on the clustering of intentionally unvaccinated children.

Using a mobile app and mobile workforce to validate data about emergency public health resources.

Background: Social media and mobile applications that allow people to work anywhere are changing the way people can contribute and collaborate.

Objective: We sought to determine the feasibility of using mobile workforce technology to validate the locations of automated external defibrillators (AEDs), an emergency public health resource.

Methods: We piloted the use of a mobile workforce application, to verify the location of 40 AEDs in Philadelphia county.

Effects of conflict-of-interest policies in psychiatry residency on antidepressant prescribing.

Concerns about the pharmaceutical industry's influence in academic medical centers and on medical education have led many medical schools and teaching hospitals to adopt conflict-of-interest (COI) policies. Although the restrictiveness of these policies differs, the goal is the same: to shield physicians-in-training from the persuasive aspects of pharmaceutical promotion. But do these policies work? This Issue Brief examines how COI policies affect the prescribing patterns of antidepressants, one of the most heavily promoted drug classes in the past decade.

Individual- versus group-based financial incentives for weight loss: a randomized, controlled trial.

Background: Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited.

Objective: To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees.

Design: Randomized, controlled trial.

Association between physicians' experience after training and maternal obstetrical outcomes: cohort study.

Objective: To assess the association between obstetricians' years of experience after training and the maternal complications of their patients during their first 40 years of post-residency practice.

Design: Retrospective cohort analysis.

Setting: Obstetrical discharges from acute care hospitals in Florida and New York between academic years 1992 and 2009.

Where are lifesaving automated external defibrillators located and how hard is it to find them in a large urban city?

Objectives: Automated external defibrillators (AEDs) are lifesaving, but little is known about where they are located or how to find them. We sought to locate AEDs in high employment areas of Philadelphia and characterize the process of door-to-door surveying to identify these devices.

Methods: Block groups representing approximately the top 3rd of total primary jobs in Philadelphia were identified using the US Census Local Employment Dynamics database.

Socioeconomic and physician supply determinants of racial disparities in colorectal cancer screening.

Purpose: Causes of racial disparities in colorectal cancer (CRC) screening may extend beyond individual-level characteristics. We examined how physician density, beyond socioeconomic factors, affected observed racial disadvantages in recent CRC screening for blacks and Hispanics.

Methods: We obtained socioeconomic and CRC screening information on adults age ≥ 50 years from the Behavioral Risk Factor Surveillance System (1997 to 2008) and information on the number of primary care physicians and gastroenterologists from the American Medical Association Masterfile (1997 to 2008).

Cost effectiveness of personalized therapy for first-line treatment of stage IV and recurrent incurable adenocarcinoma of the lung.

Purpose: Patients with epidermal growth factor receptor (EGFR) mutation-positive stage IV adenocarcinoma have improved survival with tyrosine kinase inhibitor (TKI) treatments, but the cost effectiveness of personalized first-line therapy using EGFR mutation testing is unknown.

Methods: We created a decision analytic model comparing the costs and effects of platinum combination chemotherapy with personalized therapy in which patients with EGFR mutation-positive tumors were treated with erlotinib. We used two testing strategies: testing only those with tissue available and performing a repeat biopsy if tissue was not available versus three nontargeted chemotherapy regimens (ie, carboplatin and paclitaxel; carboplatin and pemetrexed; and carboplatin, pemetrexed, and bevacizumab).

Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

Background: The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care.

Objective: We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change.

Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing?

Background: Academic medical institutions have instituted conflict of interest (COI) policies in response to concerns about pharmaceutical industry influence.

Objective: To determine whether exposure to COI policies during psychiatry residency training affects psychiatrists' antidepressant prescribing patterns after graduation.

Research Design: We used 2009 physician-level national administrative prescribing data from IMS Health for 1652 psychiatrists from 162 residency programs.

Decoding twitter: Surveillance and trends for cardiac arrest and resuscitation communication.

Aim Of The Study: Twitter has over 500 million subscribers but little is known about how it is used to communicate health information. We sought to characterize how Twitter users seek and share information related to cardiac arrest, a time-sensitive cardiovascular condition where initial treatment often relies on public knowledge and response.

Methods: Tweets published April-May 2011 with keywords cardiac arrest, CPR, AED, resuscitation, heart arrest, sudden death and defib were identified.

The impact of price discounts and calorie messaging on beverage consumption: a multi-site field study.

Objectives: To examine the efficacy of alternative approaches for shifting consumers toward zero calorie beverages. We examined the effect of price discounts and novel presentations of calorie information on sales of beverages.

Methods: This prospective interrupted time-series quasi-experiment included three sites in Philadelphia, PA, Evanston, IL, and Detroit, MI.

On the Way to Health.

Information technology (IT) has fundamentally changed the way we work, bank, and communicate. Its impact on health care and health research, however, has been limited by the lack of a comprehensive infrastructure to connect patients, providers, and researchers. As we learn more about how to address the unhealthy behaviors that underlie many chronic conditions, researchers are seeking IT solutions to connect to patients in scalable ways.

Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness.

Background: For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit (ICU).

Objective: To examine the effectiveness of LTAC transfer in patients with chronic critical illness.

Research Design: Retrospective cohort study in United States hospitals from 2002 to 2006.

Public opinion about financial incentives for smoking cessation.

Objective: The aim of this study is to assess public support for a smoking cessation policy involving financial incentives.

Methods: We conducted a randomized controlled trial using an experimental survey design. One of four questionnaire versions was distributed to participants.