RESUMO
BACKGROUND: Patients increasingly rely on web-based physician reviews to choose a physician and share their experiences. However, the unstructured text of these written reviews presents a challenge for researchers seeking to make inferences about patients' judgments. Methods previously used to identify patient judgments within reviews, such as hand-coding and dictionary-based approaches, have posed limitations to sample size and classification accuracy. Advanced natural language processing methods can help overcome these limitations and promote further analysis of physician reviews on these popular platforms. OBJECTIVE: This study aims to train, test, and validate an advanced natural language processing algorithm for classifying the presence and valence of 2 dimensions of patient judgments in web-based physician reviews: interpersonal manner and technical competence. METHODS: We sampled 345,053 reviews for 167,150 physicians across the United States from Healthgrades.com, a commercial web-based physician rating and review website. We hand-coded 2000 written reviews and used those reviews to train and test a transformer classification algorithm called the Robustly Optimized BERT (Bidirectional Encoder Representations from Transformers) Pretraining Approach (RoBERTa). The 2 fine-tuned models coded the reviews for the presence and positive or negative valence of patients' interpersonal manner or technical competence judgments of their physicians. We evaluated the performance of the 2 models against 200 hand-coded reviews and validated the models using the full sample of 345,053 RoBERTa-coded reviews. RESULTS: The interpersonal manner model was 90% accurate with precision of 0.89, recall of 0.90, and weighted F1-score of 0.89. The technical competence model was 90% accurate with precision of 0.91, recall of 0.90, and weighted F1-score of 0.90. Positive-valence judgments were associated with higher review star ratings whereas negative-valence judgments were associated with lower star ratings. Analysis of the data by review rating and physician gender corresponded with findings in prior literature. CONCLUSIONS: Our 2 classification models coded interpersonal manner and technical competence judgments with high precision, recall, and accuracy. These models were validated using review star ratings and results from previous research. RoBERTa can accurately classify unstructured, web-based review text at scale. Future work could explore the use of this algorithm with other textual data, such as social media posts and electronic health records.
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Algoritmos , Internet , Processamento de Linguagem Natural , Humanos , Feminino , Masculino , Médicos , Relações Médico-Paciente , Julgamento , Adulto , Pessoa de Meia-IdadeRESUMO
Introduction: The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina. Methods: We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives. Results: Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19. Discussion: Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.
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COVID-19 , Equidade em Saúde , Humanos , North Carolina , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Políticas , Hispânico ou LatinoRESUMO
OBJECTIVE: To examine the treatment recommendation patterns among urologists and radiation oncologists, the level of concordance or discordance between physician recommendations, and the association between physician recommendations and the treatment that patients received. METHOD: The study was a secondary analysis of data from a randomized clinical trial conducted November 2010 to April 2014 (NCT02053389). Eligible participants were patients from the trial who saw both specialists. The primary outcome was physician recommendations that were scored using an adapted version of the validated PhyReCS coding system. Secondary outcomes included concordance between physician recommendations and the treatment patients received. RESULTS: Participants were 108 patients (Mean age 61.9 years; range 43-82; 87% non-Hispanic White). Urologists were more likely to recommend surgery (79% of recommendations) and radiation oncologists were more likely to recommend radiation (68% of recommendations). Recommendations from the urologists and radiation oncologists were concordant for only 33 patients (30.6%). Most patients received a treatment that both physicians recommended (59%); however, 35% received a treatment that only one of their physicians recommended. When discordant, urologists more often recommended surgery and radiation oncologists recommended radiation and surgery as equally appropriate options. CONCLUSION: Urologists and radiation oncologists are more likely to differ than agree in their treatment recommendations for the same patients with clinically localized prostate cancer and more likely to favor treatment aligned with their specialty. Additional studies are needed to better understand how patients make decisions after meeting with two different specialists to inform the development of best practices within oncology clinics.
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Neoplasias da Próstata , Radioterapia (Especialidade) , Urologia , Masculino , Humanos , Pessoa de Meia-Idade , Urologistas , Radio-Oncologistas , Padrões de Prática Médica , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgiaRESUMO
CONTEXT: On March 19, 2020, President Donald Trump endorsed using hydroxychloroquine for COVID-19 treatment despite inconclusive evidence of the drug's effectiveness. This study sought to understand the influence of political preferences on prescription uptake by quantifying the relationship between a geographic area's partisan leaning and hydroxychloroquine prescription rates following Trump's endorsement. METHODS: We analyzed hydroxychloroquine prescriptions filled in 205 continental US designated market areas (DMAs) between March 1, 2018, and July 31, 2020, and the percentage of votes for Donald Trump in the 2016 presidential election in each DMA. We estimated associations by using an empirical strategy resembling a difference-in-differences estimation. FINDINGS: Before President Trump's endorsement, mean weekly hydroxychloroquine prescription rates were similar across DMAs with the highest and lowest Trump vote percentages (0.56 and 0.49 scripts per 100,000). After Trump's endorsement, although both high- and low-Trump-supportive DMAs experienced sharp increases in weekly hydroxychloroquine prescription rates, results indicated a 1-percentage-point increase in share of Trump votes was associated with 0.013, or 2%, more weekly hydroxychloroquine prescriptions per 100,000 people (b = 0.013, t = 2.20, p = .028). CONCLUSION: President Trump's endorsement of an untested therapy influenced prescribing behavior, especially when that endorsement aligned with communities' political leanings.
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Tratamento Farmacológico da COVID-19 , Hidroxicloroquina , Humanos , Hidroxicloroquina/uso terapêutico , Política , Prescrições , Estados UnidosRESUMO
OBJECTIVE: This study used a Social network analysis (SNA) approach to describe HIV transmission and venue affiliations among social and sexual networks of young men who have sex with men (YMSM) in Houston, TX. METHODS: A total of 34 YMSM indices aged 18-23 years and 23 of their network members were interviewed about their social and sexual networks and venues at which they met and spent time. RESULTS: Participants reported information on 220 friends (mean age = 25.3 years) and 112 sexual partners (mean age = 26.3 years). Participants spent time with friends and sexual partners at similar venues but relied more heavily on social media and dating applications to meet sexual partners. Participants lived in zip codes consistent with high concentrations of HIV positivity. Popularly frequented clubs/gay bars were often 10-20 miles away, also in zip codes with high densities of seropositivity. CONCLUSION: Both friendship and sexual networks are large, diffuse, and not limited by geography. Participants came from areas with high rates of HIV/AIDS. The venues at which participants recruited sexual partners may present increased opportunities for HIV transmission. HIV prevention interventions should focus on the heightened risk of unknown HIV serostatus.
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Infecções por HIV , Minorias Sexuais e de Gênero , Adolescente , Adulto , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Rede Social , Adulto JovemRESUMO
Each day, adolescents and young adults (AYAs) choose to engage in behaviors that impact their current and future health. Behavioral economics represents an innovative lens through which to explore decision-making among AYAs. Behavioral economics outlines a diverse set of phenomena that influence decision-making and can be leveraged to develop interventions that may support behavior change. Up to this point, behavioral economic interventions have predominantly been studied in adults. This article provides an integrative review of how behavioral economic phenomena can be leveraged to motivate health-related behavior change among AYAs. We contextualize these phenomena in the physical and social environments unique to AYAs and the neurodevelopmental changes they undergo, highlighting opportunities to intervene in AYA-specific contexts. Our review of the literature suggests behavioral economic phenomena leveraging social choice are particularly promising for AYA health. Behavioral economic interventions that take advantage of AYA learning and development have the potential to positively impact youth health and well-being over the lifespan.
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Economia Comportamental , Neoplasias , Adolescente , Terapia Comportamental , Comportamentos Relacionados com a Saúde , Humanos , Adulto JovemRESUMO
The lives of adolescents and young adults (AYAs) have become increasingly intertwined with technology. In this scoping review, studies about digital health tools are summarized in relation to five key affordances-social, cognitive, identity, emotional, and functional. Consideration of how a platform or tool exemplifies these affordances may help clinicians and researchers achieve the goal of using digital health technology to enhance clinical preventive services for AYAs. Across these five affordances, considerable research and development activity exists accompanied by signs of high promise, although the literature primarily reflects demonstration studies of acceptability or small sample experiments to discern impact. Digital health technology may afford an array of functions, yet its potential to enhance AYA clinical preventive services is met with three key challenges. The challenges discussed in this review are the disconnectedness between digital health tools and clinical care, threats to AYA privacy and security, and difficulty identifying high-value digital health products for AYA. The data presented are synthesized in calls to action for the use of digital health technology to enhance clinical preventive services and to ensure that the digital health ecosystem is relevant, effective, safe, and purposed for meeting the health needs of AYA.
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Tecnologia Biomédica/métodos , Serviços Preventivos de Saúde , Telemedicina , Adolescente , Humanos , Adulto JovemRESUMO
Assisters provide in-person and phone-based support to help consumers narrow their plan options on the Affordable Care Act's health insurance Marketplaces. We elicited the perspectives of a national sample of thirty-two assisters from ten states on consumer plan selection and available Marketplace decision support tools (for example, total cost estimators and provider network look-up tools). Assisters identified several shortcomings that limited their use of decision support tools, such as nonspecific cost estimates and inaccurate provider network data. Assisters instead provided individualized cost estimates, called provider offices to verify network coverage, and found innovative strategies to help consumers access care affordably under their chosen plan. Two priorities emerged for optimizing consumers' Marketplace insurance selection process: improve the quality of data used in decision support tools and invest in assister programs. Assister strategies should be a benchmark for improving decision support tools, with lessons to be learned for future tool development.
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Comportamento do Consumidor , Técnicas de Apoio para a Decisão , Trocas de Seguro de Saúde , Feminino , Grupos Focais , Gastos em Saúde , Trocas de Seguro de Saúde/economia , Trocas de Seguro de Saúde/organização & administração , Humanos , Seguro/economia , Entrevistas como Assunto , Masculino , Melhoria de Qualidade , Estados UnidosRESUMO
Medicaid programs are increasingly adopting incentive programs to improve health behaviors among beneficiaries. There is limited evidence on what incentives are being offered to Medicaid beneficiaries, how programs are engaging beneficiaries, and how programs are evaluated. In 2017-18 we synthesized available information on these programs and interviewed eighty policy stakeholders to identify the rationale behind key program design decisions and stakeholders' recommendations for beneficiary engagement and program evaluation. Key underlying program rationales included improving the use of preventive services and promoting personal responsibility. Beneficiary engagement strategies emphasized meeting members where they are and offering prizes or services customized for certain groups. Stakeholders recommended collaborating with external evaluators to design and conduct robust evaluations of incentive programs. Finally, stakeholders recommended aligning beneficiary incentives with provider incentives and other payment reforms through the use of common meaningful measures to streamline program evaluation.
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Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Medicaid/organização & administração , Motivação , Promoção da Saúde/organização & administração , Humanos , Participação do Paciente , Desenvolvimento de Programas , Estados UnidosRESUMO
OBJECTIVE: Adolescents and young adults remain at high risk for new HIV infections and for unknowingly transmitting the virus to others. Yet, they have demonstrated low rates of testing due to barriers such as stigma and difficulty accessing testing services. Few existing programs have successfully integrated family planning and HIV care services to improve testing and diagnosis rates among young adults and adolescents, particularly those of minority groups. This study describes the process of implementing HIV services into family planning clinics and how to train staff in routine, opt-out testing. METHODS: This study used HIV screening data from 10 family planning clinics serving adolescents and young adults in Houston, Texas. A total of 34,299 patients were tested for HIV during a 48-month study period, from January 2010 through December 2014. RESULTS: Patients tested included minors <18 years of age (25.5%), males (22.8%), and individuals who had missed opportunities for HIV testing at other health-care settings. From the opt-in period (2006-2007) to the routine, opt-out period (2008-2010), the yearly average number of tests administered more than doubled; the yearly average increased again by 50% from the routine, opt-out period to the routine, rapid period (2011-2014). Eighty-eight (0.3%) patients were diagnosed with HIV, a higher seropositivity rate than CDC's recommended threshold of 0.1% for settings where routine screening is warranted. CONCLUSION: Routine, opt-out HIV testing integrated into family planning clinics increased rates of testing acceptance, receipt of test results, and HIV-positive diagnoses among adolescents and young adults.