Health Insurance Status and Eligibility Among Patients who Seek Healthcare at a Free Clinic in the Affordable Care Act Era.

Free clinics provide care to over 1.8 million people in the United States every year and are a valuable safety net for uninsured and underinsured patients. The Affordable Care Act has resulted in millions of newly insured Americans, yet there is continued demand for healthcare at free clinics. In this study, we assessed health insurance status and eligibility among 489 patients who visited a free clinic in 2016. Eighty-seven percent of patients seen were uninsured, 53.1% of whom were eligible for health insurance (Medicaid or subsidized insurance premiums). The majority of these patients completed health insurance applications at their visit with the help of a navigator. A majority of patients who were not eligible for health insurance lacked citizenship status. This study highlights that a significant number of patients who visit free clinics are eligible for health insurance, and that free clinics are important sites for health insurance navigation programs.

Is Industry Funding Associated with Greater Scholarly Impact Among Academic Neurosurgeons?

OBJECTIVE: To determine the relationship between industry payments and scholarly impact among academic neurosurgeons. METHODS: Faculty names and academic rank data were obtained from department websites, bibliometric data were obtained from the Scopus database, and industry payment data were obtained from the Center for Medicare and Medicaid Services open payments database (openpayments.cms.gov). The h-index was used to estimate scholarly impact. Payments were classified as "general," "associated research," and "research payments." Subgroup analyses were done for academic rank, fellowship training, and sex. RESULTS: Among 1008 academic neurosurgeons, scholarly impact was greater among individuals receiving associated research industry support compared with those not receiving it. Scholarly impact also was greater among individuals who received more than $10,000 of any type of industry support compared with individuals who received less than that or no payment. This association also was seen in fellowship-trained surgeons. Female neurosurgeons were less likely than male neurosurgeons to get industry funding and were likely to get less funding. CONCLUSIONS: There is a strong association between associated research funding from industry and scholarly impact among academic neurosurgeons. It's unclear whether this association is a result of funding facilitating more research projects that eventually lead to more high-impact publications, if industry is providing more funding to academic neurosurgeons with greater scholarly impact, or whether it represents intrinsic academic activity among a group of neurosurgeons who are more likely to be academically productive and procure funding from all potential sources to increase this activity.

Personality characteristics of health care satisfaction survey non-respondents.

PURPOSE: Patient satisfaction surveys are increasingly used to assess the quality of health care delivery. Unfortunately, survey non-response may compromise generalizability (and inferential value). Although prior studies demonstrate an association between patient socio-demographic variables and response rate, relatively little information is available linking personality factors to non-response. This paper's purpose is to define outpatient satisfaction survey non-responder personality characteristics. DESIGN/METHODOLOGY/APPROACH: Minnesota Multiphasic Personality Inventory profiles of patients who completed an outpatient satisfaction survey were compared with non-responder profiles. Multivariate analysis was used to adjust for demographic and personality covariates. The study sample included 1,862 medical outpatients who were sent a satisfaction survey and Minnesota Multiphasic Personality Inventory results on record at this institution. Of these, 1,255 were survey responders and 607 were non-responders. FINDINGS: Scores on three Minnesota Multiphasic Personality Inventory scales were significantly correlated with non-response: higher scores on scales 4--Psychopathic deviate (Pd) and 8--Schizophrenia (Sc) predicted an increased likelihood of non-response (odds ratio [OR], 1.02; p < or = 0.05 for both), and higher scores on 7--sychasthenia (Pt) were associated with a decreased likelihood of non-response (OR, 0.98; p < or = 0.01). ORIGINALITY/VALUE: Prior investigations demonstrate an association between patient socio-demographic factors and survey non-response. This paper uniquely highlights patient personality characteristics' contribution to non-response. This information is an important consideration for patient satisfaction survey design, administration and interpretation.

Educational effectiveness of a personal digital assistant-based geriatric assessment tool.

BACKGROUND: Although personal digital assistant use among residents is common, few outcomes-based studies have examined the impact of this technology on medical education. AIMS: We evaluated the educational effectiveness of a personal digital assistant-based geriatric assessment tool. METHODS: Internal medicine residents were enrolled as subjects. Personal digital assistant users were randomly assigned to receive or not receive a geriatric assessment tool for use on their device. Outcome measures included pretest/posttest performance and tabulation of geriatric functional issues on hospital dismissal summaries. RESULTS: Seventy-two residents participated. Of these, 38 (53%) reported personal digital assistant use. Twenty were assigned to receive the geriatric assessment tool. Average change between pretest and posttest scores was highest for the group using the geriatric assessment tool on a personal digital assistant (2.8, P=0.01). This group also had the highest average posttest score and the highest average number of geriatric functional issues identified on dismissal summaries, but neither value was significantly different from respective averages for the other study groups. CONCLUSIONS: Residents who used a personal digital assistant-based geriatric assessment tool demonstrated greater improvement in geriatric knowledge than peers who did not use this resource. Curricula adapted to this technology may prove useful in medical education.

Survey assessment of personal digital assistant use among trainees and attending physicians.

Limited information is available on personal digital assistant (PDA) use patterns in medical settings. Recognizing that use patterns may be important considerations for development of handheld-based information systems, the authors characterized PDA use at their institution. A survey was mailed to all internal medicine physicians at the Mayo Clinic, Rochester, Minnesota, in May 2002. PDA use prevalence, user demographics, hardware preferences, and work setting and application use frequencies were assessed for respondents reporting current PDA use. Use patterns of trainees (residents and subspecialty fellows) and attending physicians were compared. Trainees reported more frequent PDA use in the hospital setting and for direct patient care. Attending physicians reported more frequent PDA use in administrative settings and for calendar functions. These findings may reflect differences in the information needs and work roles of learners and experienced physicians. Such factors may be important considerations for the development and implementation of institutional PDA resources.